The stimulation of tumor-specific T-cell responses with active immunotherapy has several theoretical advantages over other forms of cancer treatment. In order to obtain clinical benefits T cell-based immunotherapy must stimulate both CD8 and CD4 tumor-reactive T cell responses which recognize tumor specific antigens. Consequently increasing attention has focused on identifying MHC class I and II epitopes from multiple tumor associated antigens (TAAs) (Cheever, et al, 2009). However, heterogeneous expression of most of the characterized tumor antigens among the different types of cancer limits the broad applicability of cancer vaccines that target such antigens. During the past few years, human telomerase reverse transcriptase (hTERT) has emerged as the first bona fide common tumor antigen and is actively investigated as a universal target for cancer immunotherapy. Human telomerase reverse transcriptase (hTERT) is the catalytic subunit of the telomerase enzyme that synthesizes telomeric DNA at the chromosome ends. hTERT is overexpressed in most human tumors (>85%) and virtually all types of cancer. In addition, telomerase activation has become one of the most important tumor escape mechanisms to circumvent telomere-dependent pathways of cell death. It is well established that therapeutic strategies targeting antigens not involved in tumor growth can result in the selection of antigen-loss tumor mutants that are clinically progressive. Hence, down-regulation or loss of telomerase activity will severely impact the growth potential of the tumor cells. Moreover, telomerase is relatively specific of cancer cells as normal body cells express little or no telomerase for most of their lifespan and generally have longer telomeres than those in tumor cells. All these findings justify the clinical applications of hTERT for anticancer immunotherapy.
Broadly used in several anticancer vaccine trials, peptide vaccination is the most advanced strategy concerning hTERT antigen. However several factors could influence the optimal success of this peptide-based vaccine strategy, such as (1) the human leukocyte antigen (HLA) restriction, (2) the natural processing of peptides in tumor cells, (3) the loss of antigen presentation on tumor cells, (4) the functionality of antigen-specific T cells, and (5) the long term persistence of the immune responses in the host after vaccination.
The memory response obtained with peptide vaccines and especially with short peptides is very low and not persistent. These suboptimal results can be explained in part by the absence of CD4 T-cell help. In addition, the half-life of MHC/peptide vaccine complex on presenting cells is only a few hours, the peptides then disappear. The dendritic cells then no longer present peptides to lymphocytes, and hence become tolerogenic. This defect in peptide presentation can be deleterious in some cases (Rosenberg et al., 2004).